Fracture tables



R. ANDERSON FRACTURE TABLES June 2, 1964 4 Sheets-Sheet 1 Filed D60. 1,1961 INVENTOR. E0655 Awe/e s'oA W A rroems-KS' June 2, 1964 Filed Bee.1, 1961 R. ANDERSON 3,135,257

FRACTURE TABLES 4 Sheets-Sheet 2 INVENTOR. 0651? ANDEEfiO V June 2, 1964R. ANDERSON 3,135,257

FRACTURE TABLES Filed Dec. 1, 1961 4 Sheets-Sheet 3 IN VEN TOR. 2065/?ANDEEfiO/V A r TOEA/fYJ' June 2 1 Filed Dec, 1 1961 RACTURE TABLES 4Sheet 4 INVENTOR Z06? Aumses'a rams/5 y;

i United States Patent O 3,135,257 l FRACTURE TABLES Roger Anderson,4221 E. Lee St., Seattle, Wash.

Filed Dec. 1, 1961, Ser. No. 156,369

17 Claims. (Cl. 128--84) Myin vention relates to a fracture table andprimarily a table with manipulatable mechanical means to be employed by'orthopedic surgeons in connection with operatlons involving chieflybones of an extremity, as a tibia or a .femur. Examples of specificother uses will involve operations of a knee joint and at times of ahumerus.

' Other types of orthopedic operations in which the tables ofmyinvention are well adapted include: operations on limbs while inflexion, and with or without traction; cast applications; and open boneoperations, as grafting.

It is an object of my invention to provide mechanism (which maybelikened to mechanical hands), which can be caused to duplicate everymotion that can be made by the hands of the physician in positioningbones and holding or fixing any desired position including maintainng adesired degree of tension or traction while with or without the changingof the degreeof bending at the knee of the patent.

Also in the cases of deformities great versatility in the motions of themanipulation means of the fracture table are necessary to fit aparticular patient andat the same time to provide tension-in the linecoinciding with the anatomical axis of the tibia and/ or femur of apatient.

It is a further object of my invention to provide a fracture table whichinvolves a tibia support which is adjustably connected with a foot plateso that a predetermined relationship can be established between a tibiasupport and a foot plate and which will be maintained regardless ofwhether or not the extent of bending of a patients knee supported bysuch structure is changed.

It is a further object of my invention to provide structure whereby afoot plate may be secured to the foot of ap'atientand thereafter as theknee of the patient is bent the foot plate will have the desiredrelationship to the foot of the patient.

I Other objects and advantages of my invention will become apparent asthe description of the same proceeds and the invention will be bestunderstood from a consideration of the following detailed descriptionstaken in connection with the accompanying drawings forming a .part ofthe specification, with the understanding, however, that the inventionis not to be limited to the exact ldetailsof construction shown anddescribed since obvious modifications will occur to a person skilled inthis art.

FIG. 1 is a somewhat schematic and somewhat dia- ,grammatic' view inside elevation and showing by full lines bone structure and by dashlines the outline of the flesh of a leg being treated in adevice of myinvention;

FIG. 2 is a view similar to FIG. 1 showing, by full and dot and dashlines, various positions the parts may take ,when the knee of a leg israised different amounts;

'- FIG. 3 illustrates, a view similar to FIG. 1 but illustratesadjustments which may be made to accommodate a leg which cannot normallybe positioned similar to FIG. 1 because of a malformationof the leg;

' FIG. 4is a plan view and illustrates schematically adjustments whichmay be made to accommodate for malformed legs, such as a leg havingcharacteristics generally termed as knock-kneed;

ll. FIG. 5 is an'enlarged fragmentary perspective view illustrating theadjustable mechanism used in connection with my invention;

FIG. 6 is a fragmentary view partially in section and .partially inelevation, with parts broken away, taken substantially on broken line 66of FIG.,5;

3,135,257. Patented June 2., 1964 ice partly in section takensubstantially on broken line 8-8 of FIG. 7. i

Referring now to-FIGS. 1 to 4 inclusive, various positions areillustrated of one leg of a patient, such as the right leg. In use thedevice preferably will comprise mating parts for simultaneouslysupporting both a right and a left leg. The buttocks of the patient issupported by any suitable table '10 and counterpressure is effected bythe usual perineal post 12.

In accordance with'common technique, where traction is to be applied toa leg of a patient, the perineal post 12 is against pelvic bones of apatient sothat as traction is applied to one or both legs (generallybothlegs) the said perineal post, in accordance with usual practice,pro- ,vides for counterpressure against parts hereinafter described. 1

One form of a perineal post is illustrated and described in my previousLetters Patent 2,266,296 issued December 16, 1951. I p,

After the device is adjusted in accordance with structure hereinafterdescribed, the patient is positioned on the table with the buttockssupported by the table 10and with the support or pedestal 14 positionedon the, underside of the knee of the patient and supportingflesh ofthepatient covering the tibia of the patient. Then the foot is strappedto the foot plate 16 and a suitable foot plate is illustrated in myPatent 2,469,361, issued May 10,

The support 14 may be. positioned to support other bones and at variouslocations, as desired, and functions as an intermediate support betweentraction and counter-traction means. a

The foot plate 16 (see FIG. 5) carries a plate 18, which maybereleasably connected to a tongue or plate 20 on block 24 by a screw21. The locking screw 21 (shown dotted in FIG; 5) carries a turningmeans, as a knurled head 22. Thus foot plate 16 is detachably connectedwith traction rod 26. Openings 25 in block 24 willsup- .port otheraccessories, as a skeletal pin'transfixion unit ,(not shown). j f

A sleeve 37 (see FIG. 6) is rotatable in block 44 and held againstlengthwise movement thereof by collars 39 and 41. The sleeve 37 isrotatable relative to said collars 39 and 41. r The said collars 39 and41 are attached .to the block 44 by any suitable means. I

Threadedly mounted on the tractionrod 26 is.'a' locking and impactionnut 30. Nut. 30 can be turned in one direction to prevent traction rod26-from moving to the right in FIG. 6 and in the other direction toinove.trac- .tion rod 26 to the left. Such later movement will causeimp-action of afracture. The traction rod'26 is keyed to sleeve member37 by key means 32 (see FIG. 6) and is thusmounted for sliding movementin the sleeve 37. Coil spring 34 isslidable on lead screw 26 and one endportion abuts collar 39 and the other end portion abuts a tubular member36. 'The tubular member '36 abuts a traction'providing nut 38. In theeventLthat a counter-traction force is effected against block .44,.thetraction nut 38 can-be rotatedinthe appropriate-direc- -tion to providepressure and this in turn will causeconn pression of the coil spring 34.More specifically tension .on traction rod 26 is transmited through coilspring 34 28 can be readily read on the calibration scale 42 (FIG. 5) onthe sleeve member 28.

The sleeve 37 is mounted for rotary movement in block 44. Means to locksaid sleeve member 37 and in turn the traction rod 26 against rotationis provided by locking screw 46 carrying any suitable manualmanipulation means, such as handle 48. By the means just described,angular movement of the traction rod 26 may obtain or any angularposition thereof may be maintained, thus a bone fragment connected withthe traction rod 36 may be rotated and any position obtained thereof maybe maintained. Lateral-or sidewise movement of the traction rod 26 isprovided. Block 44 is pivoted about pivot means 52 relatively toadjusting block 50. A set screw 54 engages adjusting block and said setscrew 54 passes through an arcuate slot 56 (see FIG. 4) in block 44 andupon tightening of set screw 54, movement between block 44 and adjustingblock 50 is prevented. Turning movement of block 44 and in turn lateralmovement of traction rod 26 is indicated by the indicia line 58 (seeFIG. 4).

In view of the structure just described, lateralmove- V ment of thetraction rod 26 and any bone connected therewith may be obtained and anydesired position may be locked against further lateral movement.

Besides the rotary and lateral movement of the traction rod 26justdescribed, a third movement is provided by my device. This movementis a vertical or up and down movement so as to provide for universalmovement of, the traction rod 26 and parts connected therewith includingthe bone of a patient.

Such vertical angular movement (depicted by indicia line 63 in FIG. 3)of the traction rod 26 is provided by pivotally mounting adjusting block50 (see also FIG. 5) on pivots 62 carried by U-shaped yoke 64. Thispermits adjusting block 50 to move arcuately in generally a verticalplane relative to yoke 64. The amount of such movement can be adjustablylocked by pivoting a rod 66 (see FIG. 6) to block 50, as by pivot means68. A clamping member 70 is pivotally mounted to yoke 64 and may bemoved into locked or released positions by locking screw and handlemeans 72.

Thus from the foregoing it is now obvious that if the foot of' a patientis secured to foot plate 16, the foot plate 16 and the leg of a patientmay have imparted thereto the various movements just described inconnection with the traction rod 26. In other words, an extremity, as aleg, can be rotated about the anatomical axis of the tibia or humerus,or the knee of the patient can be moved angularly in a'vertical plane Orangularly in a horizontal plane and all of the various movementsdescribed including, but not limited to traction and impaction, can beseparately or collectively locked in an adjusted relative position. Allof the various movements described provide for universal movement andabout a center which is on the axis of traction rod 26.

In order to provide for ready manipulation of the various movements ofthe traction rod 26, I provide handle means 74 so that manualmanipulation toobtain the various movements is convenient. Thus forexample if the locking nut 30 is released (moved toward the left in FIG.5), a manual pull may be provided on the handle means 74 or the tractionnut 38 may be rotated in the desired direction, either of'which, willprovide tension or traction on the leg of a patient whose foot issecured to the foot plate 16 against counter traction which may beprovided, as by perineal post 12. Also by the use of said handle 74,angular movement about either the pivot 52 or the pivots 62 may obtainin either a horizontal or a vertical plane, that is sidewise or up anddown. Also the traction rod 26 can be rotated. Such move ments can beobtained regardless of whether or not locking is provided against any orall of the other movements.

As will be observed the various movements may be locked or left free. Itis often desirable to have all of them free so that by hand manipulationof the handle 74 a doctor can obtain any desired mechanical position ofthe traction rod 26 and parts connected therewith. When all movementsare free to be made, it is desirable to minimize the weight which thedoctor may handle and thus allow the doctor to feel the conditions ofthe reduction or apposition. It is very helpful for a doctor to be ableto steer with a minimum effort on his part the position of the bones inreducing a fracture.

Ithus provide link 73 which is rotatable relative to and mounted by thetraction rod 26. Suspended from the link 73 is a weight carrying rod 75and the weight 77 may be selected and the amount thereof used dependingupon forces tending to move the traction rod 26 angularly up or down.Some of these forces will be the gravity pull because of the, weight ofthe patient and the part thereof involved, and the weight of mechanicalappliances that may be employed at the time of the reducing of thefracture. The mechanical appliances include the foot plate 18 and tibiasupport means 14, 76, 80, 88, etc., extending away from the yoke 64 onwhat may be termed the inboard side thereof (i.e., the side of yokeextending toward the center of table). The counterweight means 73, 75,77, is preferably connected with the traction means adjacent the end ofthat portion of said traction means that extends outwardlyof the yoke64, such as adjacent the outboard end of traction rod 26, as illustratedin FIG. 5, for example.

Bracket 76 (see FIG. 5) is connected with block 24 and preferablydetachably connected therewith as 'by looking set screw 78. Two tubularmembers 80 are connected with said bracket 76 and preferably detachablyconnected as by locking screws 82. The tubular members 80 are slidablyreceived in a head 84 and the relative length between the bracket 76 andthe head 84 can be set by loosening set screws 86, longitudinallypositioning the head 84 on the tubular members 80 and then tighteningthe set screws 86. This is for the purpose of moving the tibia support14 relative to the foot plate 16 to adjust for patients having differentlengths of tibias. Also it may be desired to use a plurality of supports14 to support a tibia or other bones at various locations which can bereadily done by supporting the same on tubular members 80. 1

Preferaby the tubular members 80 are each made from two telescopicmembers with a sleeve 81 and set screw 83 to provide for any desiredadjustable length of the tubular members 80.

The head 84 mounts rotatable means to provide for general horizontalmovement (see FIG. 5). Rod 88, which is generally of U-shape, has, aportion thereof pivoted to head 84 to provide for general verticalmovement. Support 14 is pivoted to a horizontal portion of rod- 88. Thestructure just described provides for universal movement of support 14relative to head 84.

Thus despite any deformities or any particular size of patient and thelike, the knee or tibia support 14 may be positioned against the fleshof a patient under the tibia, diztal to or under the knee joint, orotherwise support a one.

Thus it will now be. apparent that the support 14 is positioned underthe knee of a patient and if there upon bending the knee of the patient.It is an object of this invention to maintain substantially the sametraction even thoughthere is subsequent bending of the knee of a:patient either upwardly or downwardly. Hence the reasontorthe structurenext to be described.

Thebase of supporting table 92 (FIGS. 2 and 4) supports the buttockstable and also supports a tube 94. A block 96 (FIG. 5) is slidable' ontube 94 and to providefor maintaining a relative adjusted position, alocking screw 98 is employed to maintain any'adjusted position or theblock 96longitudinally of the tube 94.

The block 96 slidably mounts a'rod 100, which ,rod 100 mounts a support102 for supporting the head 84. Thus when the head 84 is in thelowermost position (shown in FIG. 1 of the drawings) the relativeelevation ofthe adjusted position ofthe support 102 will support thehead 84 and parts connected therewith and associatedtherewithincludingthe leg of the patient. Also the rod 100 has a horizontal portion 101 toprovide a third movement of support102. Support 102 will move verticallyupon vertical movement of rod 100, longitudinally upon sliding of block96 on tube 94, or sidewise upon turning of rod 100, thussupport 102 mayalways support head 84, regardless of bend of the knee of the patient.At times chiseling action on bones is required and a direct supportobtains through support 14, rod 88, head 84, support 102, rod 100, block96, tube 94 to table 92. I

Preferably support 102 is provided with means to support otheraccessories, as a unit including skelatal transfixion pins, and holes103 are provided for this purpose. Support 102 may be positioned on tube94 'to function as an anchor for counter-traction means. By havingtherear links 112 slightly longer than the front links 110 andby havingthe lower pivotal connections thereof further spaced than the'upperpivotal connections, a given point such as 114 (FIG. 2 on the block 50will follow a path indicated by the broken line 116 of FIG. 2. It isdesired that said arc 116 be of a relatively large diameter so as toprovide a relatively flat path. However, the table must be made inpractical proportions and I obtain a relatively flat arc by the use ofthe modified form of pantograph described.

In 'order' to maintain any adjusted position of the yoke '64by movementof said links 110 and 112, I pivotally mounta rod 118 (see FIG. 5) onthe yoke64 and extend the same downwardly'toward one of the links 110and 112, such as a link 112, and slidably mount the same in a sleeve120, which sleeve 120 is pivoted on the link 112, and the extent oflongitudinal movement of the rod '118 may be selectively locked'orunlocked by locking screw means 122.

The tube 94- is pivoted to move in a horizontal plane by pivot means 124shown dotted in FIG. 2 of the draw,- -ings. 'The center of rotation isabout a vertical axis passing through the center. of articulation 126 ofthe head of a femur of a patient. This permits the whole assembly 'to beturned in a horizontal plane about a desired axis and thus the legs of apatient may be moved together or separated as desired without change ofdegree of traction. I e

1 The mode of operation in general comprises placing a patient with thebuttocks on the buttocks table or sacral'rest 10 and with the patientproperly disposed as respects the perineal post'12 or other means ofcountertraction. The patientmay have the right leg positioned 'asindicated in FIG. 1 of the drawings and with the tibia and femurpositioned as indicated. The other leg will be supported, in mostinstances, by paired mechanism (not illustrated). The relative length ofrods 94 and 104 (see .FIG. 5) will be adjusted depending upon the lengthof a particular leg involved. Tibia support means or knee support 14will be adjusted to support the tibia of a patient and below or underand distal to the knee joint. ,Adjustments of the position of tibiasupport means 14 may be made for patients having not only differentlengths of tibias, for patients having malformations, or fractures orother abnormal conditions.

"The support 14 is'secured in place and the foot secured to the footplate 16 and with the thigh and lower leg bones' appropriatelypositioned, the traction rod 26 is rotated or moved in a horizontalplane or in a vertical plane as may be indicated for a particularpatient. There may be a plurality of supports, if desired, andsupportedin the same manner.

The support 102 is properly positioned relative to the head 84.. Thenthe desired traction is placed and the traction will be along dot anddash line 128 (FIGS."1", 2, 3 and 4). Also the traction will be alongthe anatomical axis of the tibia of the patient, as along dot and dashline 130. The traction along the femur will be along dot and dash line132. Obviously the length of dot and dash line 130 between the footplate 16 and 123. and the length of dot and dash line 132 between 123.and 126 will 'not' change. One of the. principal accomplishments of thepresent invention is to predetermine the amount, if any, of traction andthereafter'bend the knee of the patient to a desired angle and at thesame time to maintain substantially the original adjusted traction. Thispermitsbende ing of a knee about its center of articulation 123 afteradjustments have been made, which is desired in many operations.

There may be changes in traction due to unusual conditions of a patientand my device readily provided for any relative minor adjustments. Ifduring the bending of a knee, the indicating pawl 40 indicates on the.calibration scale 42 a change of traction, the physician can readilymake necessary adjustments through appropriate manipulation of nuts 30or 38, or handle 74. i i

As will appear in FIG. 2 of the drawings, any given point 114 onadjusting block 50 moves along the are 116 and the distance from thepoint 114 to the ankle of the patient remains the same even though thearigularity of flexing of the knee of the patient is changed. Also itwill be noted that the lengths of the lines 130 and 132 between 114,123and 123, 126 remain the same. Thus there is substantially no change intension even though the knee of the patient is bent to expedite'anyparticular operation. p The block 44 will maintain its same angularrelation to the foot plate 16 regardless of whether the parts are in theposition shown'in FIG. '1 or.FIG.'2 of the drawings. Thus as the block44 angularly moves relative to the vertical because of the modifiedpantograph involving links links 112 and base 108 as well asblock"64lsupporting the same, there is a turning movement imparted'tothe foot plate 16prelative to the vertical and' this turning movementtends to support a knee as it moves vertically, both against anytendency to move up or 'downJAt the same time the under knee support ortibiasupport maintains its same relative position to the foot plate 16and thus there is no change in traction; In other words, maintaining thesame relative position betweentheknee joint and the support 14 relativeto the foot plate 16,

to andat; the desired relative position to the footplate 16. Then thesaid handles 60 and 48 and 72 are tightened to maintain the desiredfixed angular relationshipbetween the yoke 64 and the block' 44. This inturn fixes the relationship between the foot plate 16 and the .yoke 64.As the yoke 64 is mounted by the modified pantograph, involving links110 and 112 and base 108, the foot plate 16 is angularly moved as theknee of a patient rises or is bent and by such action there is apushingfor supporting'movement of the foot tending to push or pull theknee. i 5 Referring now to FIGS. 7 and 8 of the drawings, there usefulwhere all of the various features and advantages of the structure shownin FIGS. 1 to 6 inclusive are not desired. 1

The tube 140 is shown broken awayv and will have a function similar totube 94 to support similar parts. Any suitable mounting means for thetube 140 may be employed. The tube 140 preferably telescopically mountsa rod 142 and the clamping means 144 provides for ad justable engagementso a suitable extension in length of 140142 may obtain. Base means 146is connected to rod 142 and said base means 146 supports column 148. Keymeans 150 is provided to prevent turning motion between base 146 andcolumn 148. A yoke 152 is pivotally mounted on column 148 and retainerscrew 154 joins yoke 152 and column 148 together for relative rotarymotion between the two.

'- Column 148 terminates in a shaft portion 156 and column 148 isrotatably mounted relative to the yoke 152 through a suitable bearing inyoke 152 mounting shaft portion 156.

A locking shaft 158 is mounted for sliding movement in a suitableopening in yoke 152. Boltand handle means, threadedly connected withyoke 152, are suitable for moving the locking shaft 158 into and out oflocking position with shaft portion 156. Locking shaft 158 has aninclined portion 161 so that upon longitudinal movement of said lockingshaft 158 it may be moved into and out of a wedgingposition, thus intoand out of locking position.

: The yoke 152 has spaced apart upwardly projecting plate portion 162which mount spaced apart pivot means 164 which pivotally mount block 166for up and down movement about a horizontal axis.

The block 166 mounts therein parts described in connection with FIG. 6of the drawings and the parts correspond as follows: sleeve 168 to 37;collar 170 to 41; collar 172 to collar 39; from such parts and from thedescription of their counterparts in FIG. 6, sleeve 168 is mounted forrotary movement in block 166. p

The traction rod 174 and key means 176 are the counterparts of tractionrod26 and key means 32 of FIG. 6. Thus the traction rod 174 will turnwhenever the sleeve 168 turns but the traction rod 174 is slidable inthe sleeve 168.

Coil spring 178 is mounted on traction rod 174 and one end portionthereof abuts against collar 172 and the other end portion thereofagainst nut 181. Link '180 corresponds to link 73; rod 182 to rod 75;counterweights 184 to counterweights 77; and handle 186 to handle 74.Locking and counter-traction nut 188 corresponds to locking andcounter-traction nut 30.

In order to selectively lock the sleeve 168 from ro tation and in turnthe traction rod 174, I may provide locking means having the identicalconstruction described in connection with locking column 148 fromturning relative to the yoke 152. Thus in the parts illustrated, lockingshaft 190 corresponds to 158 and locking shaft 192 to 158 and bolt means192 and any suitable handle (not shown) corresponds to 160.

Yoke 152 has spaced apart plate portions 194 and one thereof is threadedand receives threaded portion of a locking bolt 198. Suitable boltturning means are provided as by handle 200. A locking yoke 202 isrotatively mounted on the locking bolt-198. A rod 204 is slidablethrough an opening in the locking yoke 202. Upon tightening of thelocking bolt 198 sliding movement of the rod 204 relative to the lockingyoke 202 is prevented. An end portion of the rod 204 is pivotallyconnected with the block 166 as by pivot means 206. When the said rod204 is free to slide in the locking yoke 202, then the block 166 is freeto pivot on pivot means 164. As the traction rod 174 moves with the saidblock 166,this will permit up and down movement of the traction rod.

The traction rod 174 may carry the same accessories as were carried bythe lead screw 26 and thus the parts correspond as follows: tongue 208to 18, tongue 210 to 20,

knurled head 212 to 22, foot plate 214 to 16, block 216 to 24, andopenings 218 to. 25. Said openings are designed to be a part'of themounting means for usual skeletal transfixion pins (not shown) and thusfunction as an anchor to a distal end portion of a bone. Hole 219 isdesigned to receive the locking set screw 78 (FIG. 5) and support theparts 76, 80, 81, 82, 83, 84, 86, 88, and 14 which are not illustratedin FIGS. 7 and 8 but are incorporated by reference.

Many complications may be involved infracture and other bone cases. Forexample, in fracture cases we may have multiple fractures and thelocation of the fracture or fractures requires a device which canmechanically (with or Without mechanicaladvantage) take substantiallyall positions that the hands of a surgeon can take. Also in fracturecases it is highly desirable to be able to manually or mechanically pushor pull and .to rotate sidewise as well asup and down or a combinationof these. Also it is desirable to have mechanical means to maintain aparticular position or positions obtained while making another orothers. The device of this invention permits a combination of thevarious conditions which may arise in fracture cases.

In the structure of FIGS. 1 to 6, particularly 1 to 4, a usual perinealpost is depicted as an illustration of a counter traction means. vIt isto be understood that other usual counter traction means may beemployed, such as a saddle or skeletal transfixion pins.- When a saddleis employed it is normal for a patient to be a lateral position, or onone side. In FIGS- 6 and 7 no counter-traction means is illustrated asonly a fragment of the tube 140 is shown, however the samecounter-traction means described in connection with FIGS. 1, 2 and '5may be employed in connection therewith. Also as to traction, this maybe applied through foot plates 16 or 214 or through transfixion pinmeans supported by blocks 24 or 216 by employing openings 25 or 218. I I

The traction means of the various forms of my invention all provide fora shaft or rod, as traction rod 26 of FIGS. 1 to 6, or the traction rod174 of FIGS. 7 and 8. In both forms of the invention shown, the rod(such as the traction rod is movable up and down, in and out orsideways, and is rotatable. The advantage of using a traction rod is tobe able to employ the traction nut 38 or 181 and locking and impactionnut 30 or 188 to provide respectively for mechanical pull and pushmovements. All the various movements are about a center which is on theaxis of the traction rod and there is universal movement about suchcenter.

In addition to the movements which are common to both FIGS. 1 to 6 andto FIGS. 7 and 8, the structure of FIGS. 1 to 6 inc. provide theadditional movement obtained by the modified pantograph embodying linksand 112 and associated parts. j

In the forms of my invention illustrated, a counterweight may beemployed so that a physician is-not required to support weight and thusis in a position to delicately manipulate a fracture and feel" andprecisely guide exactly as the conditions of the bones under treatmentnecessitate.

Also there is universal movement about the anatomical centers of a limbof a patient and this is maintained despite the various manipulationswhich are being made.

, In the event impaction is desired (pushing together fractured endportions of bones), the nut 30 of FIGS. 1 to 6 or the nut 188 of FIGS. 7and 8, may be moved toward the block 44 or block 166 and a distal bonefragment may be moved by the device to cause impaction between the sameand a proximal bone fragment.

While I have illustrated traction, rods 26 and 174, shafts, rods ortubes with. friction locking couplings to maintain an adjusted positionmay be employed to advantage. A very definite advantage of the presentinvention is that a physician is able to employ mechanical devices,obtain mechanical leverages and locking results, individually or 9collectively'thereof and also to be able to hand manipulate any movementas desired. A

Obviously changes may be made in the mechanical parts illustratedwithout departing from the principle of; my lIlVeHtiOIl. i

I claim: I

1. A fracture table comprising therein components designed particularlyfor utility in connection with orthopedic' treatment of the leg of apatient comprising a pelvic engaging means functioning ascounter-traction means; adjustable traction means including an elementconnectible ,With the lower end portion" of a leg of a patient, saidtraction means offering traction in said leg away from said p'elvicengaging means; support means for said traction means including a base;a rigid frame member extending between and rigidly connecting saidcounter-traction means with said base; tibia supporting means connectedand movable in fixed relation with the element of said traction meansthat is connectable with the lower end portion of the leg; and meansmounting said element and said tibia supporting means forxlongitudinalrotational, sideways and up and down movement of a lower end portion ofa leg of a patient connected to. said'element and supported by saidtibia supportingmeans, relative to said support means. g 9

2 A fracture table comprisin'gtherei'n components designed particularlyfor utility in connection with orthopedic treatment of the leg of apatient comprising a pelvic engaging means functioning ascounter-traction means and relatively positionable against thepelvicbones of a patient; adjustable traction 'rneans connectible with thelower end portion of a tibia of the patient and affording traction inthe leg of the patient away from said-pelvic v engaging means,supporting means for said traction means comprising fixed baseme ans,continuous links pivotally connecting with said fixed base means atth'eirlower end portions, and yoke rneans pivotally connecting withrtheupper end portions of said links and also connecting with said tractionmeans; and means mounting said traction means for at least sidewaysmovement relative-to said yoke. 3. A fracture table comprising thereincomponents designedparticularly for utility in connection with.orthopedic treatment of the legs of a patient comprising a pelvicengaging means functioning as counter-traction means and relativelypositionable against the pelvic bones of a patient; adjustable tractionmeans connectible with a lower end portion of the tibia of the patientand affording traction in the leg of the patient away from the saidpelvic engaging means; movable supporting means for said traction meanscomprising base means, continuous links pivoted at their lower endportions to said base means, and yoke means pivoted to the upper endportions of said links and connecting to said traction means; tibiasupporting means connected with and movable in fixed relation with saidadjustable traction means; and means mounting said traction means andsaid tibia supporting means for rotational, sideways and up and downmovement relative to said yoke.

4. A fracture table comprising therein components designed particularlyfor utility in connection with orthopedic treatment of the legs of apatient comprising pelvic engaging means functioning as counter-tractionmeans and relatively engageable with the pelvic bones of the patient;adjustable traction means including a foot plate connectible with thefoot of a patient and affording traction in the leg of the patient awayfrom said pelvic engaging means, said adjustable traction means furtherincluding an elongated member connecting at one end with said footplate; support means for said adjustable traction means including ayoke; tibia supporting means connected with and movable in fixedrelation with said foot plate and -said elongated member; and means formounting said elongated member, said foot plate and said tibia support-10 ing means for rotational, sideways and up and down movement relativeto 'said yoke.

5. The combination of claim 4, wherein said tibia supporting meansincludes a rod means carried by and posi tioned below the axis of saidelongated member.

.6. The combination of claim 5, wherein said tibia supporting meansfurther includes a tibia supporting member and adjustable means formounting said supporting member onto said rod means. 1

7. A fracture table comprising a fixed support; counter-traction meansrelatively fixed on said support; and a traction means carried by saidfixed support, thetraction means including a traction rod and meansmounted on one end thereof and connectible to the limb of a patient,said traction rod having a longitudinal axis; a first adjustable meansmounting said traction rod for rotational movement about itslongitudinal axis; a second adjustable means providing for sidewaysrotary movementof said traction rod about an axis intersecting at rightangles the longitudinal axis of said traction rod; and third adjustablemeans providing for up and down rotary movements of said traction rodabout a horizontal axis intersecting the longitudinal axis of saidtraction rod.

8. The-combination of claim 7, wherein the traction rod is threaded andmeans cooperating with said threaded traction rod are provided forincreasing and decreasing the amount of traction in the leg of apatient.

9. A fracture table comprising a counter-traction means engageable withthe proximal end portion of a bone of a patient; traction meansincluding an element engageable with the distal end portion of said boneof the patient; bone supporting means positionable between saidcountert'raction means and said traction means and carried by saidtraction means; and adjustable means providing for rotary movement ofsaid traction means and the bone supporting means as a unit about afirst axis and sideways and up and down movements about axesintersecting said first axis at points passing through said tractionmeans outboard of the element engageable with the distal end portion ofthe bone of the patient. p 10. A fracture table comprising acounter-traction means engageable with the proximal end portion of alimbof a patient; traction means engageable with the distal end portion ofsaid limb of the patient, said traction means including a threadedtraction rod and means cooperating with said traction rod for increasingand decreasing the amount of traction put on the bone of said limb;support means for said traction means including a yoke, with a portionof said traction means extending inboard of said yoke and anotherportion thereof extending outboard ofthe yoke; adjustable meansproviding for sideways, up and down and rotary movement of said tractionrod relative to said yoke; handle means connected with an outboardportion of said traction means; and counterweight means connected withthe outboard end portion of said traction means and counterweighting thecombined weights of the inboard portion of the traction means and thelimb of the patient during up and down movement of the traction means.

11. A fracture table comprising a counter-traction means engageable withthe proximal end portion of a bone of a patient; traction meansengageable with the distal end portion of said bone of the patient;support means for said traction means including a mounting member;adjustable means for said traction means providing for rotation thereofabout a first axis and sideways and up and down movements thereof aboutseparate axes which intersect said first axis and pass through saidmounting member, thereby allowing from a predetermined position forsideways, up and rotary movements of said traction means withoutlessening the amount of traction on the bone of the patient, andseparate locking means to lock each one of said movements individually.

12. A fracture table comprising pelvic engaging means functioning ascounter-traction means and relatively en'- gageable with the pelvic boneof a patient; means con meeting said pelvic engaging 'meanswith anelongated support member situatedsubstantially at right angles to saidpelvic engaging means; base means connected with the end of saidelongated support member situated away from said pelvic engaging means;adjustable traction means situated above said base means and including afoot supporting means; support means for said traction means locatedabove said base means; a mounting member for the adjustabletractionmeans forming a part of said support means; tibia supporting meanscantilevered from said foot supporting means and including an element onwhich the undersurface of a leg of a patient rests; and meansinterconnecting said support means and said base means and providing formovement of said foot supporting means and said tibia supporting meansas a unit during flexion and extension of the .knee of the patient, saidsupport means further including means providing for rotation of thetraction means about a first axis and sideways and up and down movementthereof about separate axes which intersect said first axis and passthrough said mounting member.

13. The combination of claim 12, wherein a telescoping rod means iscarried by the elongated support member andextends to contact andsupport said tibia supporting member.

14. A fracture table comprising a counter-traction means engageable withthe proximal end portion of a bone of a patient; traction meansincluding a traction rod and means engageable with the distal endportion of said bone of the patient; a first adjustable means providingfor rotary movement of said traction means about the longitudinal axisof said traction rod including a sleeve surrounding said traction rod; asupport block surrounding said sleeve; sleeve locking means in saidsupport block; second adjustable means providing for sideways movementof said traction means about an axis passing through the longitudinalaxis of said traction rod and through the sleeve and the support block;and third-adjustable means providing for up and down movement of saidtraction means about a transverse axis passing through the longitudinalaxis of said traction rod.

15. The combination of claim -14,'wherein a handle means connects withsaid adjustable traction means and extends a substantial'distance fromsaid transverse axis on the side thereof away from said bone engagingmeans.

16. The combination of claim 15, wherein counterweight means connectedadjacent said handle means, such counterweight means lessening theamount of patient and apparatus weight which the doctor must move andthereby making it possible for the doctor to steer with a minimum efforton hispart the position of the bones in reducing a fracture.

17. A fracture table comprising therein components designed particularlyfor utilityin connection with orthopedic treatment of the leg of apatient comprising a pelvic engaging means functioning as countertraction means and relatively positionable against the pelvic bones of apatient; adjustable traction means connectable with the lower endportion of a tibia of the patient and affording traction in the leg ofthe patient away from said pelvic engaging means; movable supportingmeans for said traction means comprising base means, continuous linkspivotally connecting with said base means at their lower end portions,and yoke means pivotally connecting with the upper end portions of saidlinks and also connecting with said traction means; and tibia supportingmeans connected with and movable'in fixed relation relative to saidtraction means, said base means, the links and the yoke means togetherforming a trapezium, with the side thereof formed by the yoke meansbeing shorter than the side thereof formed by the base means and theside thereof formed by the links nearest to the pelvic engaging meansbeing shorter than the side thereof formed by the links furthest fromthe pelvic engaging means.

References Cited in the file of this patent UNITED STATES PATENTS

1. A FRACTURE TABLE COMPRISING THEREIN COMPONENTS DESIGNED PARTICULARLYFOR UTILITY IN CONNECTION WITH ORTHOPEDIC TREATMENT OF THE LEG OF APATIENT COMPRISING A PELVIC ENGAGING MEANS FUNCTIONING ASCOUNTER-TRACTION MEANS; ADJUSTABLE TRACTION MEANS INCLUDING AN ELEMENTCONNECTIBLE WITH THE LOWER END PORTION OF A LEG OF A PATIENT, SAIDTRACTION MEANS OFFERING TRACTION IN SAID LEG AWAY FROM SAID PELVICENGAGING MEANS; SUPPORT MEANS FOR SAID TRACTION MEANS INCLUDING A BASE;A RIGID FRAME MEMBER EXTENDING BETWEEN AND RIGIDLY CONNECTING SAIDCOUNTER-TRACTION MEANS WITH SAID BASE; TIBIA SUPPORTING MEANS CONNECTEDAND MOVABLE IN FIXED RELATION WITH THE ELEMENT OF SAID TRACTION MEANSTHAT IS CONNECTABLE WITH THE LOWER END PORTION OF THE LEG; AND MEANSMOUNTING SAID ELEMENT AND SAID TIBIA SUPPORTING MEANS FOR LONGITUDINALROTATIONAL, SIDEWAYS AND UP AND DOWN MOVEMENT OF A LOWER ENE PORTION OFA LEG OF A PATIENT CONNECTED TO SAID ELEMENT AND SUPPORTED BY SAID TIBIASUPPORTING MEANS, RELATIVE TO SAID SUPPORT MEANS.